Profit And Loss Statement Page 5

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Privacy and your personal information
Your personal information is protected by law, including the Privacy Act 1988 , and is collected by the Australian Government Department
of Human Services for the assessment and administration of payments and services. This information is required to process your application
or claim.
Your information may be used by the department or given to other parties for the purposes of research, investigation or where you have
agreed or it is required or authorised by law.
You can get more information about the way in which the Department of Human Services will manage your personal information, including
our privacy policy at or by requesting a copy from the department.
www. .
I declare that:
• the information provided in this form is complete and correct.
Your statement
I understand that:
• giving false or misleading information is a serious offence.
• the Australian Government Department of Human Services can make
relevant enquiries to make sure I receive my correct entitlement.
Your signature
On completion of this form,
please print and sign by hand.
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